Individual
MICHAEL JAY HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
1202 23RD STREET SOUTH, FARGO, ND 58103
(701) 293-5429
(701) 293-0736
Mailing address
1202 23RD STREET SOUTH, FARGO, ND 58103
(701) 293-5429
(701) 293-0736
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
302532
MN
Other
Enumeration date
07/16/2009
Last updated
07/16/2009
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